Data interpretation

Question 1

What blood result would be concerning in a patient on Clozapine?

Answer 1

neutropenia

Question 2

Give 4 causes of hypernatremia

Answer 2

Dehydration
Drips (too much IV saline)
Drugs
Diabetes insipidus

Question 3

3 causes of microcytic anaemia

Answer 3

Iron deficiency anaemia
Thalassaemia
Sideroblastic anaemia

Question 4

3 causes of normocytic anaemia

Answer 4

Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)

Question 5

3 causes of macrocytic anaemia

Answer 5

B12/ folate deficiency
Excess alcohol
Liver disease
Hypothyroidism
Multiple myeloma, myeloproliferative/myelodysplastic disease

Question 6

What is the normal range for sodium?

Answer 6

135-145 mmol/L

Question 7

What is the normal range for potassium?

Answer 7

3.5-5 mmol/L

Question 8

What are some causes of high neutrophils (neutrophilia)?

Answer 8

Bacterial infection
tissue damage (inflammation, infarct, malignancy)
Steroids

Question 9

What are some causes of low neutrophils (neutropenia)?

Answer 9

Viral infection
Chemo/radiotherapy
Clozapine
Carbimazole

Question 10

What are some causes of high lymphocytes (lymphocytosis)?

Answer 10

Viral infection
Lymphoma
Chronic lymphocytic leukaemia

Question 11

What are some causes of low platelets (thrombocytopenia)?

Answer 11

Reduced production:
- infection
- Drugs (penicillamine)
- myelodysplasia, myelofibrosis, myeloma
Increased destruction:
- heparin
- hypersplenism
- DIC
- ITP
- haemolytic uraemic syndrome/ thrombotic thrombocytopenic purpura

Question 12

What are some causes of high platelets (thrombocytosis)?

Answer 12

• bleeding
• tissue damage
• post splenectomy
• myeloproliferative disorders

Question 13

What are some causes of hyponatraemia?

Answer 13

Hypovolaemic
- fluid loss (D+ V)
- Addison’s disease
- Diuretics
Euvolemic:
- SIADH
- psychogenic polydipsia
- hypothyroidism
Hypervolemic
- Heart failure
- Renal failure
- Liver failure
- Nutritional failure

Question 14

What are some causes of Hypokalaemia? (DIRE)

Answer 14

• Drugs (loop and thiazide diuretics)
• Inadequate intake or intestinal loss (D+V)
• Renal tubular acidosis
• Endocrine (Cushing’s and Conn’s)

Question 15

What are some causes of Hyperkalaemia? (DREAD)

Answer 15

• Drugs (loop and thiazide)
• Renal failure
• Endocrine (Addison’s)
• Artefact
• DKA

Question 16

Raised urea with a normal creatinine in a patient who is not dehydrated may indicate what?

Answer 16

Upper GI bleed

Question 17

What is the biochemical disturbance in prerenal AKI?

Answer 17

Urea rise> creatinine rise

Question 18

What are some causes of prerenal AKI?

Answer 18

Dehydration
Renal artery stenosis
Shock

Question 19

What is the biochemical disturbance in intrinsic renal AKI?

Answer 19

Urea rise<creatinine rise

Question 20

What are some intrinsic causes of AKI? (INTRINSIC)

Answer 20

• Ischaemia (due to prerenal AKI causing acute tubular necrosis)
• Nephrotoxic antibiotics
• Tablets (ACEi, NSAIDs)
• Radiological contrast
• Injury (rhabdomyolysis)
• Negatively birefringent crystals (gout)
• Syndromes (glomerulonephridites)
• Inflammation (vasculitis)
• Cholesterol emboli

Question 21

What is the biochemical disturbance in postrenal AKI (obstructive)

Answer 21

Urea rise< creatinine rise (bladder or hydronephrosis may be palpable depending on level of obstruction)

Question 22

What are postrenal causes of AKI?

Answer 22

In lumen: stone or sloughed papilla
In wall: tumour
External pressure: BPH, prostate cancer, lymphadenopathy, aneurysm

Question 23

What are some common causes of a raised alk phos?

Answer 23

• Any fracture
• Liver damage
• K (cancer)
• Paget’s disease of the bone/Pregnancy
• Hyperparathyroidism
• Osteomalacia
• Surgery

Question 24

What are some prehepatic causes of a raised bilirubin?

Answer 24

Haemolysis
Gilbert’s and Crigler-Najjar

Question 25

What are some causes of a raised bilirubin and AST/ALT

Answer 25

fatty liver hepatitis cirrhosis Malignancy metabolic (Wilsons/haemochromatosis) Heart failure (causing hepatic congestion)

Question 26

what are some causes of a raised bilirubin and ALP?

Answer 26

Gallstone drugs causing cholestasis tumour primary biliary cirrhosis sclerosing cholangitis pancreatic or gastric cancer

Question 27

What drugs can cause cholestasis?

Answer 27

Flucloxacillin Co-amoxiclav Nitrofurantoin Steroids Sulphonylurea's

Question 28

How should you adjust levothyroxine dose based of TSH?

Answer 28

<0.5 = decrease dose 0.5-5 = no action >5 = increase dose

Question 29

What would TFT's be in primary hypothyroidism?

Answer 29

T4 = low TSH = high

Question 30

What are some causes of primary hypothyroidism?

Answer 30

Hashimoto's thyroiditis Drug induced

Question 31

What would TFT's be in secondary hypothyroidism?

Answer 31

T4 = low TSH = low

Question 32

What is a cause of secondary hypothyroidism?

Answer 32

pituitary tumour or damage

Question 33

What would TFT's be in primary hyperthyroidism?

Answer 33

T4 = high TSH = low

Question 34

What are some causes of primary hyperthyroidism?

Answer 34

Grave's disease toxic nodular goitre Drug induced

Question 35

What would TFT's be in secondary hyperthyroidism?

Answer 35

T4 = high TSH = high

Question 36

What is the main cause of secondary hyperthyroidism?

Answer 36

pituitary tumour

Question 37

How do you assess the quality of a chest x-ray film? (PRIM)

Answer 37

- Projection - Rotation - Inspiration - Markings

Question 38

What on a blood gas indicates a respiratory problem

Answer 38

PaCO2 abnormality

Question 39

What on a blood gas indicates a metabolic problem

Answer 39

HCO3 abnormality

Question 40

What on a blood gas is the difference between T1 and 2 respiratory failure

Answer 40

type 2 has a high PCO2

Question 41

What does 1st degree heart block look like on an ECG

Answer 41

PR interval constant but >1 large square

Question 42

What does 2nd degree heart block look like in ECG?

Answer 42

- increasing PR interval then missing QRS then increasing again - 2/3 p waves for every QRS

Question 43

What does 3rd degree heart block look like on ECG?

Answer 43

no relationship between p and QRS

Question 44

What does atrial fibrillation look like on ECG

Answer 44

- no P waves - Irregular QRS

Question 45

What does Left BBB look like on ECG?

Answer 45

V1 = W V6 = M

Question 45

What on ECG indicated Bundle branch block?

Answer 45

QRS width >3 small squares

Question 46

What does Right BBB look like on ECG?

Answer 46

V1 = M V6 = W

Question 47

How do you calculate if someone has left ventricular hypertrophy?

Answer 47

add largest deflection of QRS in V1 to that in V6, if above 3.5 large squares then LVH

Question 48

How do you know if a patient on oxygen is hypoxic from an ABG?

Answer 48

take away 10 from oxygen requirement, PaO2 should be this of higher

Question 49

Name 2 causes of elevated ST segment

Answer 49

1. Infarction 2. pericarditis

Question 50

Name 2 causes of depressed ST segment

Answer 50

1. Ischaemia or infarction 2. digoxin

Question 51

What does T waves >2/3rds height of QRS indicate?

Answer 51

hyperkalaemia

Question 52

In what leads is T wave inversion normal

Answer 52

aVR and I

Question 53

What can T wave inversion indicate?

Answer 53

old infarction/LVH

Question 54

Features of Digoxin toxicity

Answer 54

confusion Nausea visual halos arrhythmias

Question 55

Features of late lithium toxicity

Answer 55

arrhythmias seizures coma renal failure diabetes insipidus

Question 56

Features of Phenytoin toxicity

Answer 56

Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy Teratogenicity

Question 57

Features of Gentamycin and vancomycin toxicity

Answer 57

Ototoxicity and nephrotoxicity

Question 58

What action should you take if INR is increased and there is minor bleeding

Answer 58

Omit warfarin and give 1-5mg IV vitamin K